CASE

PRESENTATION
Presented By :
GOKUL. A. J
2nd Pharm. D
(17Q3009)
DEMOGRAPHIC FEATURES
 Name: ABC
 Age: 56yrs
 Gender: Male
 Date of admission (DOA) : 06/8/18
 Date of discharge (DOD) : 10/8/18
PROBLEM LIST

 Acute allergic Asthmatic bronchitis

SUBJECTIVE EVIDENCE

 Fever since 5 days

 Cough with expectoration since 5 days
 Burning micturition since 5 days
OBJECTIVE EVIDENCE

 On physical examination: P-I-C-CL-E-

 Vital signs:
 Pulse rate (PR) : 90bpm
 Blood pressure (BP) : 150/80mmHg
 Temperature : 100o F
 Respiratory system : NVBS+; Rhonchi +
 CVS : S1S2 heard ; no added murmurs
LABORATORY
INVESTIGATIONS
 USG(ultra - sonography / urine specific gravity): urinary bladder
wall thickening
 Haemoglobin (13.5 – 17.5 gm/dl) : 10.4gm/dl
 ESR(0 – 20 mm/Hr) : 35 mm/Hr
 DAILY INVESTIGATION
CHART

DAY BLOOD PRESSURE TEMPERATURE

6/8/18 150/80 mmHg 100 F

7/8/18 130/80 mmHg 100 F

8/8/18 130/80 mmHg 98.6 F

9/8/18 140/90 mmHg

10/8/18 140/90 mmHg

 ASSESSMENT

 Diagnosis:
• By subjective and objective evidence, the patient was
diagnosed to have Acute Allergic Asthmatic Bronchitis.

 Etiology:
 Occupation – Industrial worker
 CURRENT THERAPY
S. GENERIC NAME BRAND DOSE FREQ ROU D1 D2 D3 D4 D
N NAME UENC TE 5
O Y

1 INJ. HYDROCORT 50mg 1-1-1 IV  

HYDROCORTISONE

2 NEB.SALBUTAMOL + DUOLIN 1.25mg/2. Q6H 2-3     

IPRATROPIUM 5ml + puffs
BROMIDE 0.5mg

3 DEXTROMETHORPH BRONCHOPHAN 10 ml 1-1-1 PO     

AN SYRUP

4 NEB. BUDESONIDE BUDECORT 200mg Q12H 2-3    

INHALATION puffs

5 AMOXICILLIN + CAREMOX AG 1g +0.2g Q12H IV     

CLAVULANIC ACID

6 T.PARACETAMOL DOLO 650mg 1-1-1 PO     

7 INJ PANTOPRAZOLE OLGERD 40mg Q12H IV     

 INJ HYDROCORTISONE
(HYDROCORT)
50 mg 1-1-1 IV
 Category: Anti asthmatic
 Indications: Bronchial infection
 Mechanism of action (MOA): Moderate anti inflammatory action.
 Contraindications (CIs): Hypersensitivity
NEB.SALBUTAMOL (1.25mg/2.5ml) +
IPRATROPIUM BROMIDE (0.5mg)
(DUOLIN) Q6H (2-3 puffs)

 Category:
o Salbutamol: beta 2 agonist
o Ipatropium bromide: anti-cholinergic

 Indication: Asthma
 MOA:
o Ipratropium Bromide: It inhibits the increase in mucus secretion by
blocking muscuranic receptor; they produce broncho dilation.
o Salbutamol: Beta 2 adrenergic bronchodilator.
 ADRs: Bronchitis
 CI: Hypersensitivity to salbutamol, ipratropium, soy products.
DEXTROMETHORPHAN SYRUP
(BRONCHOPHAN) 10ml 1-1-1 (PO)

 Category: Anti-tussives
 Indications: Cough suppressant
 Mechanism of action (MOA): Suppresses the cough reflex by a
direct action on the cough center in the medulla of the brain.
 STD Dose: 10-20 ml
 ADRs: Dizziness, Nausea
 CIs: Persistent or chronic cough.
NEB. BUDESONIDE (BUDECORT)
Q12H 200mg 2-3 puffs
 Category: Corticosteroid
 Indication: Airway inflammation
 MOA: Inhaled steroids suppress bronchial inflammation, by
inhibiting the inflammatory mediators.
 STD Dose: 200 mg
 ADRs: Respiratory infection
 CI: Hypersensitivity to budesonide
T. PARACETAMOL( DOLO)
650mg 0-0-1 PO
 Category: Antipyretic
 Indication: Fever
 MOA: It produces anti-pyresis by inhibiting the hypothalamic heat-
regulating centre.
 STD Dose: 500mg-650mg
 CI: Hypersensitivity
 AMOXICILLIN+CLAVULANIC
ACID (INJ. CAREMOX AG) 1.2g
Q12H IV
 Category: Penicillin Antibiotic
 Amoxicillin – Antibiotic
 Clavulanic Acid – Beta lactamase inhibitor
 Indications: Lower respiratory tract infections
 MOA:
 Clavulanic acid : Increase spectrum of action and restore efficacy
against amoxicillin-resistance bacteria that produce beta-lactamase.
 Amoxicillin: Inhibiting bacterial cell wall synthesis
 ADRs: Diarrh0ea
 CI: Allergy to penicillin
INJ. PANTOPRAZOLE
(OLGERD) 40mg OD IV

 Category: Proton pump inhibitor

 Indication: Gastro protective
 MOA: It binds to H+/K+ exchanging ATPase in gastric parietal cells,
resulting in blockage of acid secretion.
 STD Dose: 40mg
 ADRs: Headache, abdominal pain, chest pain
 CI: Hypersensitivity
DISCHARGE MEDICATIONS

 T. Amoxicillin + Clavulanic acid 250mg 1-0-1 × 7 days

 T. Pantoprazole 40mg 1-0-0 × 7 days
 Syp. Budesonide 5ml 1-1-1 × 10 days
 T. Theophylline + Etophylline 150mg 1-0-1 × 15 days
 T. Paracetamol 650mg × 5 days
GOALS

 SHORT TERM GOALS:

 Symptomatic relief
 Prevent and treat exacerbations
 Reduce disease progression

 LONG TERM GOALS:

 To improve quality of life.
 To reduce morbidity and mortality.
MONITORING PARAMETERS

 THERAPEUTIC MONITORING
 Pulmonary function tests (PFT)
 Urine analysis
 Vital signs
POINTS TO PATIENT

 Disease:
 You have been suffering with asthama, which is a condition that
can make breathing difficult, take medications according to the
physician’s prescription.
 Managing your asthma correctly is very important for leading an
active and healthy life.
 Lifestyle modifications

 Avoid environmental asthma triggers by wearing mask when exposed to

dust, pollens and pets.
 Take plenty of oral fluids.
 Do exercise regularly.
 Take medications regularly.
FOLLOW UP

 To review in medicine OPD after 15 days.